Breast CA Flashcards Preview

Undeleted > Breast CA > Flashcards

Flashcards in Breast CA Deck (74):
1

what is functional part of breast

ducts and lobules

2

3 locations of drainage -nodal

1. axillary - most
2. internal mammary
3. infra/supraclavicular

3

what cells surround a lobule

double cell layer
1. inner duct-lubular- milk cells
2. myoepithelial cells- muscle

4

what happens to breast as ages

fibrous CT is replaced with radiolucent adipose tissue

5

what are borders of breast exam

clavicle, sternum, axilla, inframammary ridge

6

what to look for on breast exam

breast
- size and shape
- change in contour
- color
- nipple
lymphatics
- mass
-

7

**what are most breast lumps

majority are benign
- fibroadenoma, fibrocystic changes
- risk for CA increases with age

8

** what is triple test for lump

1. clinical exam
2. biopsy
3. imaging

9

non-modifiable risk factors for CA

- age
- positive family Hx
- BRCA
- previous breast CA
- mantle radiation
- reporductive issues
- breast density
- ashkenazi Jewish

10

6 modificable risk factors

1. diet
2. vitamins
3. alcohol
4. obesity
5. sedentary lifestyles
6. HRT use

11

3 risk reduction strategies

1. lifestyle mod
2. suregry
3. chemo

12

what is effect of alcohol

1.5x for 3-5/day
- worse for HRT

13

how can excercise help

some walking helps

14

what is chemoprevention

tamoxifene daily for 5 years

15

4 methods of breast screening

1. breast awareness
2. clinical breast exam
3. mammography
4. MRI

16

what is breast awareness

women getting to know thair breasts so they can see what is abnormal

17

when should breast exams be used

no longer reccomended - not good data

18

when should mammogram be done

every 2-3 years starting at 50

19

what are probs with mammography

1. false positives
2. hard to see in dense breasts
3. over diagnosis of DCIS

20

when to use screening MRI

in high risk patients
- BRCA
- chest irradiation before 30

21

should we give mammography in women under 40

lady thinks we should if PT wants

22

when to stop mammography

when less than 10 years life expectancy

23

what to do if BRCA carrier

annual mam and MRI starting at 30

24

when do errors occur in diagnosis

1. self detected
2. young
3. negative mam
4. non-lump presenting form
5. preg or breast fedding

25

3 imaging modalities

1. mamm
2. MRI
3. ultrasound

26

how many images on mam

2x
1. craniocaudal
2. mediolateral

27

what is BI-RADS system

rating system in which higher scores are worse

28

4 potential things to find on mammogram

1. assymetries
2. distortion
3. masses
4. calcificaitons

29

when to use ultrasound

when can't get mamm or MRI for some reason

30

when to use MRI (4)

1. staging
2. high risk screening
3. evaluation surgical margins
4. monitoring chemo

31

what are 3 genetic factors involved in breast

1. BRCA
2. li fraumeni
3. cowden

32

what is BRCA

tumor supressor genes
- when mutated get increased risk of carcinoma

33

what are 2 pathologic risk factors

1. proliferative breast disease
2. preinvasive in situ

34

what are epithelial breast lesions

wide variety of alterations that may be benign

35

how are epithelial lesions defined

1. non-proliferative
2. proliferaitve without atypia
3. proliferative with atypia

36

what are fibrocystic changes

NON-proliferative and BENIGN alterations that are very common
- often bilateral and focal
- may be painful
- maybe due to hormones

37

what is proliferative breast disease (2 types)

1. without atypia - florid ductal hyperplasia
2. with atypia - beginning to resemble carcinoma in situ

38

**what is key to proliferative breast disease

myoepitelial layer is preserved

39

what is DCIS

preinvasive lesion in which the lesion proliferates within the duct and myoepithelial layer is intact
- may involve the nipple

40

what is paget's disease

crrusted red nipple that may be associted with DCIS or carcinoma

41

4 features to presentation of carcinoma

1. plapable mass
2. nipple changes
3. skin changes
4. mammographic features

42

2 ways to diagnose breast carcinoma

1. cytology - fine needle biopsy - cannot diagnose invasion
2. histology - preferred - core biopsy

43

2 general classifications of carcinoma

1. not special type (NST) - most common
2. special type - better prognosis

44

3 general gene profiles of CA and prognosis

1. luminal - ER/PR+ - best prognosis
2. basal - ER/PR and Her2 -ve - poor prognosis
3. her2 - low ER/PR - poor prognosis

45

what can we give to Her2 +ve

trastuzumab - herceptin

46

when does CA not require staging

early breast CA - >5cm and no node

47

what are 2 types of surgeries

1. masectomy
2. lumpectomy

48

what goes with lumpectomy and why

radiation - major risk reduciton

49

what to do with sample after lumpectomy

mammogram to see if there is still calcificaitons and margin

50

what is better surgery

equivalent with radiation

51

what are 5 absolute indications for masectomy

1. multicentric
2. some collagen vascular disease
3. pt choice
4. prior radiation
5. preg

52

when is axiallary surgery done

usually onyl for CA, except DCIS with masectomy

53

why do axillary surgery

many nodes not accurately examined
- nodal spread is prognostic

54

what is sentinal node biopsy

give blue dye and then pull out first node that should drain the area

55

who should get sentinal node biopsy (3)

1. T1,2 CA with clinically neg nodes
2. multicentric CA
3. DCIS with mastectomy

56

what to do with positive node

may not do complete dissection if:
- post meno, had lumpectomy, systemic therapy

57

when to do chemo

depends on a variety of PT factots

58

when to radiation

always after lumpectomy

59

when in breats CA inoperable

when can't remove it all with a surgery

60

why give neo-adjuvant chemo (3)

1. assess response to chemo
2. prognostication
3. shrink tumor before

61

3 types of systemic therapy

1. chemo
2. endocrine
3. herceptin

62

how does neo adjuvant compare to adjuvant

comparable

63

who is most likely to benefit from chemo

those with a worse prognosis - more reduction in risk

64

what is best prognosic group for breast

luminal A - ER/PR+ and her2 neg

65

what is treatment for luminal A

hormones and maybe chemo (pt preference)

66

what is 21 gene recurrence score (21-RS)

cancer and reference genes that give an idea about risk

67

what is most modern and used chemp

3rd gen

68

short term SE of chemo

- hair loss
- nausea/vomiting
- mucostitis
- fatgure
- febrile neutropenia

69

long term SE of chemo -

- infert
- early menopause
- cardiomyopathy
- secondary leukemia
- neurotoxicity

70

what are 2 hormone theapry types

1. tamoxifen - block receoptos
2. aromatase inhibitors

71

what are adv. and dis of tomoxifen

adv: good for bones, CV risk
dis - bad for thrombolsis, stroke, CA

72

what are adv. dis of AI

more CV risk, more lipids, more osteo

73

how long to give for

may give for 10 years for higher risk PTs

74

what are potential survivorship issues

1. hot flashes
2. vaginal dryness
3. cognitive funciton
4. fatigue
5. psychosocial impact

Decks in Undeleted Class (589):